Surgical stapling instrument

ABSTRACT

A surgical stapling instrument ( 1 ) comprises a body portion ( 2, 3 ), a handle ( 4 ) and a staple fastening assembly ( 8 ). The staple fastening assembly ( 8 ) includes a curved cartridge ( 10 ), which comprises at least one curved open row of staples, and a curved anvil ( 22 ), which is adapted to cooperate with the cartridge ( 10 ) for forming the ends of the staples exiting from the cartridge ( 10 ). The staple fastening assembly ( 8 ) is adapted to allow unobstructed access towards the concave inner faces of the cartridge ( 10 ) and the anvil ( 22 ). The cartridge ( 10 ) can be moved towards the anvil ( 22 ) from a spaced position for positioning tissue therebetween to a closed position for clamping the tissue. Preferably, a knife is contained within the cartridge ( 10 ) and is positioned such that there is at least one row of staples on at least one side of the knife.

[0001] This application is related to the following copending patentapplications: application Ser. No. 10/287/066 filed on Nov. 4, 2002.

FIELD OF THE INVENTION

[0002] The invention relates to a surgical stapling instrument, whichcan be used, e.g., in the diagnosis and therapy of all pathologies besttreated by a curved stapled resection. It provides a means to extend thetransluminal exploitation of mechanical suturing devices introduced viathe anal canal, mouth, stomas, and service accesses. The treatment ofrectal pathologies will be described as most frequent, but not only useof the invention.

BACKGROUND OF THE INVENTION

[0003] The current transanal surgical procedure of choice is TransanalEndoscopic Microsurgery, which, however is burdened with difficulty ofexecution and complications such as dehiscence and abscesses. Currentendoscopic excisions of, e.g., peduncular polyps usually do not allownecessary histological examination. This is of particular concern whenthe sample turns out to be malignant and the site is no longer visibleduring follow-up surgery. In the case of sessile polyps, the endoscopicexcision presents similar drawbacks, and in addition difficulties inretrieving the sample, a related high loss of blood, and a risk ofperforation of the intestinal wall. Traditional surgical excisions, forexample via Transanal Endoscopic Microsurgery, are complicated andinvolve the intraluminal dissemination of neoplastic cells.

[0004] WO 97/47231 discloses an endoscopic stapler including a staplinghead which is removably located on the distal end of an endoscope. Thestapling head includes a stationary part, which houses a removablestaple cartridge, and a movable part which includes an anvil forreceiving and bending the ends of staples fired from the staplecartridge. The stationary part has a circular cross-sectional area, butthe staples are arranged in two semi-circular rows, in which the staplesare staggered relative to each other. The cross-sectional shape of theanvil is semi-circular, generally matching the rows of staples. Aftertissue to be excised has been clamped by moving the anvil towards thestationary part, the staples are consecutively expelled from the staplecartridge, and a knife cuts the tissue to be excised by moving along astaple line. Since the access for manipulating the tissue in order toplace it correctly in between the anvil and the stationary part issomewhat obstructed by the cross-sectional shape of the stationary part,a remote-controlled forceps device is provided in the region of thestaples and the anvil.

[0005] In U.S. Pat. No. 5,355,897, a surgical stapler is shown whichderives from the well-known circular staplers for performing ananastomosis. In order to enable the local excision of tissue by means ofthis instrument, instead of a circular anastomosis, a shield extendingaround part of the periphery of the stapling region prevents unwantedtissue from entering the head of the device. A similar instrument isknown from U.S. Pat. No. 5,360,154. In both cases, the region betweenthe anvil and the staple cartridge is not easily accessible.

[0006] Surgical staplers comprising a staple cartridge having one ormore straight rows of staples and a cutting blade running in parallel tothe staples are disclosed in U.S. Pat. Nos. 4,665,916 and 4,881,545. Inthese instruments, tissue to be stapled and excised can be clampedbetween the staple cartridge and an anvil which is pivotally connectedto the staple cartridge at one of its ends. Staplers having straightrows of staples, in which the staple cartridge can be moved in parallelrelationship with respect to a stationary anvil in order to clamp thetissue to be stapled and excised, are known from U.S. Pat. Nos.4,527,724, 5,137,198, and 5,605,272; these staplers are not providedwith an automated cutting device. Generally, in many applications,straight staplers are not anatomically correct, i.e. straight staplelines do not fit a circular lumen contour.

[0007] U.S. Pat. No. 4,617,928 discloses a surgical instrument forpractising mechanical sutures and biopsies. This instrument comprises afixed anvil and a staple cartridge (including a knife), which can bemoved towards the anvil in order to clamp tissue between the anvil andthe staple cartridge. In one embodiment, there are two staple rowsarranged in a V-shaped configuration around a V-shaped knife. In anotherembodiment, an approximately semi-circular double row of staplessurrounds an approximately semi-circular knife. In this embodiment,which is designed for practising pulmonary biopsies, free access to theinner faces of the cartridge and the anvil is hindered by an armsupporting the cartridge.

[0008] The object of the present invention is to provide an economicalsurgical stapling instrument for stapling (and optionally resecting)tissue, in particular inside the digestive track, which can be operatedand used in a safe, effective, and fast manner.

[0009] This problem is solved by a surgical stapling instrument havingthe features of claim 1. Advantageous versions of the invention followfrom the dependent claims.

[0010] The surgical stapling instrument according to the inventioncomprises a frame having a body portion and a handle extending from thebody portion in the proximal end region of the instrument. A staplefastening assembly is mounted in the distal end region of theinstrument. Here and in the following, the terms “proximal” and “distal”relate to the user as reference, which means that the parts of theinstrument close to the user under normal operating conditions aredesignated as “proximal”.

[0011] The staple fastening assembly includes a curved cartridge, whichcomprises at least one curved open row of staples, and, at the distalend of the instrument, a curved anvil, which is adapted to cooperatewith the cartridge for forming the ends of the staples exiting from thecartridge. The staple forming plane of the anvil is arrangedtransversally with respect to the longitudinal axis of the body portionof the instrument. The staple fastening assembly is adapted to allowunobstructed access towards the concave inner faces of the cartridge andthe anvil and thus to the tissue to be resected.

[0012] A cartridge moving device is adapted to move the cartridgeessentially in parallel relationship towards the anvil from a spacedposition for positioning tissue therebetween to a closed position forclamping the tissue. The staples can be driven out of the cartridgetowards the anvil by means of a staple driving device.

[0013] Herein, the term “staple” is used in a very general sense. Itincludes metal staples or clips, but also surgical fasteners made ofsynthetic material and similar fasteners. Synthetic fasteners usuallyhave a counterpart (retainer member) held at the anvil. In this sense,the terms “anvil” and “staple forming plane” also have a broad meaningwhich includes, in the case of two-part synthetic fasteners, theanvil-like tool and its plane where the retainer members are held, andsimilar devices.

[0014] Preferably, a knife is contained within the cartridge and ispositioned such that there is at least one row of staples on at leastone side of the knife. The knife is moved towards the anvil by means ofa knife actuating device. If the stapling instrument does not include aknife, tissue to be resected after stapling can be cut by means of aseparat surgical instrument.

[0015] The main advantage of the surgical stapling instrument accordingto the invention is its ability to allow endoluminal tissue resectionsand stapling through direct vision. Additionally, separate optics (e.g.,an endoscope) can be used as an option. When the instrument isintroduced into, e.g., the anal canal, free view onto and access to thesite of the tissue to be resected is not obstructed by any parts of theinstrument. The tissue to be excised can be pulled into the area inbetween the anvil and the cartridge, when the cartridge is in a spacedor open position, by means of a separate gripping instrument. Because ofthe unobstructed access towards the concave inner faces of the cartridgeand the anvil, the gripping instrument can be used easily, effectivelyand safely. Afterwards, the cartridge is moved towards the anvil inorder to clamp the tissue. A particular advantage is that the surgeoncan well observe the clamping procedure when the movable cartridgeapproaches the resting anvil. When the cartridge has reached the closedposition, the surgeon can “fire” the instrument, which means that thestaples are driven out of the cartridge, penetrate the tissue, whereupontheir ends are bent by the anvil, and the knife is moved towards theanvil in order to cut the tissue. When the instrument is retracted, thecompletely excised tissue stays in the staple fastening assembly and canthus be safely removed from the patient's body.

[0016] The surgical stapling instrument according to the inventionallows, e.g., the removal of a peduncular polyp and surrounding mucosafor optimal histological examination. Moreover, a valuable trace in theform of staples is left in the patient's body which allows to find thesite of the operation at a later time easily if a subsequent examinationis required. In the case of sessile polyps, the advantages of theinstrument are the rapid deployment of sterile sealing means (i.e.staples) and a low blood loss. Optimal histological examination resultsare possible because a good definition of possible muscular andperirectal infiltration of neoplastic cells is allowed. In the case ofbenign polyps and early diagnosed rectal cancer, the surgical procedurecan be considered curative.

[0017] Examples for other applications of the surgical staplinginstrument according to the invention are the treatment of mucosaprolapses of the rectum, rectoceles, anterior prolapses of the rectum,rectal prolapses, rectal ulcers, stenoses (e.g., at an anastomic site),Meckel diverticulum, esophageal pathologies, the transrectal stapling oftrauma wounds, the intussusception of the rectum, and the resection ofpolyps via service enterotomy.

[0018] Preferably, the outer faces of the cartridge and the anvil areergonomically shaped to match the anatomy of the internal lumen of thedigestive track. The cartridge and the anvil can have a generallyarc-like shape in the cross-sectional plane, the arc extending over anangle in the range 90° to 270°.

[0019] In an advantageous version, the staple fastening assemblyincludes a curved guide portion, wherein the cartridge is mounted formovement between the distal end of the guide portion and the anvil.Preferably, the shape of the guide portion is arc-like in thecross-sectional plane and is similar to that of the cartridge and theanvil, allowing an unobstructed access towards the concave inner face ofthe guide portion as well. Preferably, the guide portion and the anvilare rigidly connected by means of at least one arm extending from atleast one end of the anvil and generally running in parallel to thelongitudinal axis of the body portion of the instrument. This arm doesnot interfere with surgical instruments used for manipulating the tissueto be excised and does not block the surgeon's view. A staple fasteningassembly designed in this way greatly facilitates the surgicalapplications of the instrument.

[0020] In an advantageous embodiment, there is at least one row ofstaples on each side of the knife. The advantage of this arrangement isthat the tissue is safely held on both sides of the knife when the knifecuts the tissue, thus ensuring a clean excision of the tissue. Anotheradvantage is that hemostasis of the resected site is maintained duringthe procedure. The staples sticking in the excised tissue are removedfrom the patent's body together with that tissue specimen.

[0021] The distance between the cartridge and the anvil in the closedposition is preferably adjustable. For example, the cartridge movingdevice can comprise an adjustable stop in order to prevent the cartridgefrom moving beyond the stop position and from clamping the tissue toomuch. Or a series of cartridges with different built-in tissue stops canbe used according to the tissue thickness. It is also conceivable to usea series of cartridges which have different longitudinal dimensionswhich are adapted to the desired distance between the cartridge and theanvil in the closed position. By adjusting the distance between thecartridge and the anvil in the closed position, the instrument can bematched to the thickness and type of tissue to be excised.

[0022] In an advantageous version, the staple driving device is adaptedto simultaneously drive the staples out of the cartridge towards theanvil, and the knife actuating device is adapted to cause the knife toprotrude from the cartridge after the staple points have been driven outof the cartridge. In this design, pre-ferably the staple driving deviceand the knife actuating device are mechanically coupled for operationvia a common trigger. This way of controlling the operation of thestaples and the knife ensures a well-defined and clean cutting line inthe tissue, while the handling is easy.

[0023] Preferably, the cartridge is removable so that a used cartridgewithout staples can be replaced with a fresh one, if required. This isparticularly advantageous if the instrument is to be used several timesduring the same surgical procedure. It is also conceivable to design theinstrument as a re-usable instrument which is sterilized after eachsurgical procedure. In this case, a fresh and sterile cartridge can beinserted during the next surgical procedure.

[0024] When the cartridge is removable, it can be mounted, e.g., in acartridge holder which embraces the cartridge along the periphery of anarc-like shape in the cross-sectional plane. This design still allows anunobstructed access towards the concave inner face of the cartridge,i.e. up to the concave inner face of the cartridge holder, which matchesthe shape of the cartridge in the cross-sectional plane.

[0025] In another advantageous version, the knife is removable. Thisallows the selection of a knife of given dimensions or cuttingproperties, which is optimized to the surgical procedure in question,e.g., to the timing required when the staples penetrate the tissue andthe tissue is cut, or simply a replacement of the knife if desired.

[0026] Preferably, the cartridge moving device includes a trigger lever(preferably close to the handle) for actuating the movement of thecartridge. Alternatively, the cartridge moving device can include athreaded shaft which is mounted in the body portion and coupled to arotatable knob. In this case, the longitudinal movement of the cartridgefor approaching the anvil is activated by rotating the knob. Mechanismsfor effecting these kinds of movements are generally known in the priorart, see, e.g., U.S. Pat. No. 4,527,724.

[0027] Preferably, the anvil has an atraumatically shaped distal endregion, which facilitates, e.g., the insertion of the instrument intothe rectum and the advancement of the instrument inside the lumen.

[0028] In an advantageous embodiment of the invention, the staplefastening assembly is removably mounted in the distal end region of thebody portion. This allows the frame of the instrument and many parts ofthe cartridge moving device, the staple driving device and the knifeactuating device to be designed as re-usable components, which aresterilized after each surgical procedure, whereas the staple fasteningassembly can be replaced after each surgical procedure.

[0029] In the following, some advantages of the surgical staplinginstrument according to the invention are summarized: It is possible toperform a surgical procedure under local anaesthetics or spinalsedation. Generally, the procedures are fast and relatively easy. Theblood loss tends to be low. It is possible to apply sterile staples in aseptic field, which reduces the incidence of dehiscence and abscesses.Tumors with a diameter of up to about 3 cm can be excised. It ispossible to identify the type of locally advanced tumors and todetermine the tumor “T” level because the tumor site is visible when theinstrument is used and the excised tissue can be safely removed by meansof the instrument for pathological examination. Moreover, possiblemucosa or muscular infiltration can be identified (in the case of lowercarcinomas, the infiltration stage is a useful tool in the decision toproceed with anterior resection or amputation). The surgical site wherethe staples have been left behind can be quickly identified, e.g., byusing X-rays. The instrument provides the ability to remove advancedgrowing or stenotic rectal neoplasias via a minimal invasive approach inpoor condition patients for which a radical procedure is not indicated.It is also conceivable to use the instrument as a suturing device afterthe completion of a transanal endoscopic microsurgery.

[0030] Moreover, the instrument can be used as a distal stump suturingdevice in the lower anterior resection when a double stapling techniqueis performed. To this end, the instrument allows rectal stump closurewith the instrument introduced via a laparoscopic approach. Theinstrument also allows an improved rectal stump closure, which is usefulbecause it eliminates the “Dog Ears” effect after colorectalanastomosis. Finally, the instrument allows the sealing of the specimenwith a line of staples.

[0031] The surgical stapling instrument according to the invention canbe even used for the excision of tumors larger than 3 cm. In this case,tissue wall mobilization is required, which can be achieved via alaparoscopic approach, via an anterior perineal access for the anteriorwall, or via a posterior perineal access for the posterior wall andmultiple applications of the reloadable device (i.e. of the instrumenthaving the cartridge replaced after each firing of staples out ofseveral actuations).

[0032] In the following, the invention is described in more detail bymeans of an embodiment. The drawings show in

[0033]FIG. 1 an isometric view of an embodiment of the surgical staplinginstrument according to the invention, which includes a frame and astaple fastening assembly with a cartridge and an anvil, the cartridgebeing spaced from the anvil,

[0034]FIG. 2 an isometric view of the instrument after moving thecartridge into a closed position,

[0035]FIG. 3 an isometric view of the instrument after firing thestaples,

[0036]FIG. 4 a magnified isometric view of the staple fastening assemblyof the instrument, the cartridge being unlocked from the cartridgeholder,

[0037]FIG. 5 a view as in FIG. 4 with the cartridge fully inserted,

[0038]FIG. 6 an isometric view onto the staple forming surface of theanvil of the instrument,

[0039]FIG. 7 an isometric view of the cartridge of the instrument,

[0040]FIG. 8 a longitudinal section through the staple fasteningassembly along the line V-V in FIG. 5 after moving the cartridge into aclosed position, but before firing the staples,

[0041]FIG. 9 a longitudinal section as in FIG. 8, but after firing thestaples and cutting the tissue, and

[0042]FIG. 10 a schematic isometric view of the use of the instrumentfor removing a polyp in a patient's rectum.

[0043]FIG. 1 illustrates a preferred embodiment of a surgical staplinginstrument 1. The instrument 1 has a frame comprising a body portion,which includes a proximal section 2 and a shaft 3, and a handle 4. Thehandle 4 extends from the proximal end region of the body portion and isclose to a lever 5 and a trigger 6 for actuating the instrument 1, asexplained below in more detail. Whereas the proximal section 2, thehandle 4, the lever 5, and the trigger 6 are ergonomically shaped forfacilitating the handling and manipulation of the instrument 1, theshaft 3 has a small cross-sectional area so that it does not block asurgeon's view onto a staple fastening assembly 8, which is mounted atthe distal end 9 of the shaft 3, and provides sufficient support for thedistal end region of the instrument.

[0044]FIG. 1, FIG. 2, and FIG. 3 show the instrument 1 in threedifferent operating states which can be achieved by actuating (i.e.turning towards the handle 4) the lever 5 and the trigger 6,respectively. The details of the different states of the staplefastening assembly 8 are explained below.

[0045]FIG. 4 is a magnified view of the staple fastening assembly 8. Itincludes a curved cartridge 10 which has an arc-like shape in thecross-sectional plane, the arc extending over an angle of about 180° inthe embodiment. The cartridge 10 can be removed from the rest of thestaple fastening assembly 8 and is mounted in a cartridge holder 12 bymeans of a bayonet locking 14. In FIG. 4, the cartridge 10 is shown inan unlocked state, slightly pulled out of the cartridge holder 12. Thecartridge holder 12 is matched to the arc-like shape of the cartridge 10in the cross-sectional plane and extends over an arc angle of about 180°as well. In FIG. 5, the cartridge 10 has been fully inserted into thecartridge holder 12 and is locked in the bayonet locking 14.

[0046] The proximal portion of the cartridge holder 12 is designed as aslider 16 which is narrower (seen in radial direction) than the distalportion of the cartridge holder 12. The slider 16 is slidably mounted ina guide portion 18, as is evident from FIGS. 4 and 5. By shifting theslider 16 inside the guide portion 18, the cartridge holder 12 includingthe cartridge 10 can be moved in the direction of the longitudinal axisL of the shaft 3. FIGS. 1 and 5 display a spaced position, when theshoulder of the cartridge holder 12 comes in close proximity to thedistal end 19 of the guide portion 18.

[0047] The outer periphery of the guide portion 18 is similar to that ofthe distal portion of the cartridge holder 12, but because of an arm 20,its angle of arc is slightly larger than that of the cartridge 10. Thearm 20 is rigidly connected to one end of the guide portion 18 and runsin parallel to the longitudinal axis L. It supports an anvil 22 havingan atraumatically shaped distal end region 24 and a staple forming planeor surface 26, see FIG. 6. In the embodiment, the staple forming plane26 is arranged at an angle of 90° with respect to the longitudinal axisL of the shaft 3. However, different transversal angles are conceivableas well. Moreover, it is possible to imagine the use of two arms tosupport the anvil, e.g., one arm at each of both ends of the guideportion.

[0048] As shown in FIG. 6, the staple forming plane 26 of anvil 22includes a plurality of staple forming depressions 28, which arearranged in three curved or arc-like open rows. In between the innermostrow and the middle row, there is a continuous arc-like depression 30 foraccommodating the end of an arc-like knife (see below).

[0049] As illustrated in FIG. 7, the cartridge 10 is provided with aplurality of slots 32 which are arranged for cooperation with the stapleforming depressions 28 and run in three curved or arc-like open rows 34,35, and 36. A knife guide 38, which is aligned to the knife depression30 in the mounted state of the cartridge 10, is visible in between rows34 and 35.

[0050] Before continuing with the description of the details of staplefastening assembly 8 by means of FIGS. 8 and 9, the overall geometry ofthe staple fastening assembly 8 is emphasized once again. Because of thegenerally arc-like shape (in the cross-sectional plane) of the guideportion 18, the cartridge holder 12, the cartridge 10, as well as theanvil 22 and the arrangement of the arm 20, the staple fasteningassembly 8 allows a free and unobstructed access towards the concaveinner faces 40 of the cartridge holder 12 (and thus towards the concaveinner face 41 of the cartridge 10), 42 of the anvil 22 and 44 of theguide portion 18, see FIG. 5. Consequently, tissue in the area of thegap between the cartridge 10 and the anvil 22, when the cartridge 10 isin the spaced or open position as shown in FIG. 5, can be easilyaccessed and manipulated by means of separate surgical instruments.

[0051]FIGS. 8 and 9 are sectional views of the staple fastening assembly8 along the line V-V of FIG. 5. FIG. 8 illustrates how the slider 16 ofthe cartridge holder 12 is guided inside the guide portion 18, whichenables a longitudinal movement of the cartridge holder 12 including thecartridge 10. In this way, by actuating lever 5, the cartridge 10 can bemoved towards the anvil 22 from the open position shown in FIGS. 1 and 5to a closed position as shown in FIGS. 2 and 8. A mechanism foreffecting this movement by means of the lever 5 is described, e.g., inU.S. Pat. No. 5,605,272. During the movement, the cartridge 10 maintainsits parallel relationship with respect to the staple forming plane 26 ofanvil 22.

[0052] In the closed position, tissue can be clamped in between thecartridge 10 and the anvil 22. It is advantageous, when the residual gapbetween the distal end of cartridge 10 and the staple forming plane 26can be adjusted in order to prevent the tissue from being excessivelycompressed. Details on the mechanism of an adjustment device can befound, e.g., in U.S. Pat. No. 4,527,724. As an alternative to anadjustment device in the mechanism of the instrument, it is possible touse a set of cartridges in which each cartridge is designed for adifferent residual gap. This can be achieved, e.g., by differentthicknesses (i.e. dimensions along the direction of the longitudinalaxis L) of the distal section of a guide 50 (see next paragraph).

[0053] As shown in FIGS. 7 and 8, the cartridge 10 comprises a guide 50provided with the slots 32 and the knife guide 38. At its proximal orbottom side, the cartridge 10 is open so that a pusher 52 can be shiftedby means of a bar 53 which is guided inside the slider 16. The pusher 52holds staples 54, 55, and 56, i.e. the staples of the rows 34, 35, and36, as well as an arc-like knife 58.

[0054] When the trigger 6 is actuated by drawing it towards the handle 4(see FIG. 3), the bar 53 and the pusher 52 are moved in distaldirection, see FIG. 9. In this way, the staples 54, 55, and 56 areexpelled from the cartridge 10. Moreover, the knife 58 is moved indistal direction as well. Since the distal edge of the knife 58 runsbehind the pointed ends of the staples 54, 55, 56 (see FIG. 8), theknife 58 reaches the tissue clamped in between the cartridge 10 and theanvil 22 after the staples 54, 55, 56 have penetrated the tissue. Thisprevents the tissue from being displaced during the cutting process.After the knife 58 has cut the tissue, the excised tissue specimencontains the row 34 of staples 54, whereas the tissue remaining in thepatient is held approximated by two rows 35, 36 of staggered staples 55,56.

[0055] An embodiment of a possible mechanism for achieving the movementof bar 53 when the trigger 6 is actuated, is described in U.S. Pat. No.5,605,272. This document also discloses some safety features whichprevent the instrument 1 from being actuated or fired accidentally.

[0056]FIG. 10 illustrates in a schematic way how the instrument 1 can beused in order to resect a polyp 62 from a patient's rectum 60. Theinstrument 1 is inserted via the anal canal, the cartridge 10 being inthe spaced or open position with respect to the anvil 22, as shown inFIG. 10. Now the polyp, or more precisely, healthy tissue in the areasurrounding the polyp, can be pulled into the gap between the cartridge10 and the anvil 22 by means of a separate surgical gripping instrumentor traction sutures previously applied. This procedure is greatlyfacilitated by the curved shape of the guide portion 18, the cartridge10, and the anvil 22 as well as the small cross-sectional area of theshaft 3, as already explained above. A separate endoscopic opticalsystem can be helpful, but is not required. After the polyp has beensecured, the cartridge 10 is moved towards the anvil 22 up to the closedposition in order to clamp the tissue, as described above. Afterwards,the instrument 1 is fired, i.e. the trigger 6 is actuated which causesthe staples to be expelled and the knife 58 to cut the tissue. Thepointed ends of the staples are bent by the anvil 22. When theinstrument 1 is retracted from the patient, the excised polyp 62including the row 34 of staples is removed together with the staplefastening assembly 8 for pathological examination.

[0057] Other surgical procedures using the instrument 1 as well as theadvantages thereof have already been mentioned in the introductory partof the description.

[0058] In special embodiments, the radius of curvature (e.g., of thecartridge, the cartridge holder, the open row(s) of staples, the knife,and/or the anvil) can be large or very large, up to infinite.

1. A surgical stapling instrument comprising: a frame having a bodyportion (2, 3) and a handle (4) extending from said body portion (2) inthe proximal end region of said instrument (1), a staple fasteningassembly (8) in the distal end region of said instrument (1), saidstaple fastening assembly (8) including a curved cartridge (10), whichcomprises at least one curved open row (34, 35, 36) of staples (54, 55,56), and, at the distal end of said instrument (1), a curved anvil (22),which is adapted to cooperate with said cartridge (10) for forming theends of the staples (54, 55, 56) exiting from said cartridge (10), thestaple forming plane (26) of said anvil (22) being arrangedtransversally with respect to the longitudinal axis (L) of said bodyportion (3) of said instrument (1), said staple fastening assembly (8)being adapted to allow unobstructed access towards the concave innerfaces (40, 41, 42) of said cartridge (10) and of said anvil (22), acartridge moving device (5, 12, 16, 18) adapted to move said cartridge(10) essentially in parallel relationship towards said anvil (22) from aspaced position for positioning tissue therebetween to a closed positionfor clamping the tissue, and a staple driving device (6, 52, 53) adaptedto drive the staples (54, 55, 56) out of said cartridge (10) towardssaid anvil (22).
 2. Stapling instrument according to claim 1,characterized by a knife (58), which is contained within said cartridge(10) and which is positioned such that there is at least one row (34,35, 36) of staples (54, 55, 56) on at least one side of the knife (58),and a knife actuating device (6, 52, 53) adapted to move said knife (58)towards said anvil (22).
 3. Stapling instrument according to claim 2,characterized in that there is at least one row (34; 35, 36) of staples(54; 55, 56) on each side of said knife (58).
 4. Stapling instrumentaccording to one of claims 1 to 3, characterized in that said cartridge(10) and said anvil (22) have a generally arc-like shape in thecross-sectional plane, the arc extending over an angle in the range 90°to 270°.
 5. Stapling instrument according to one of claims 1 to 4,characterized in that said staple fastening assembly (8) includes acurved guide portion (18), wherein said cartridge (10) is mounted formovement between the distal end (19) of said guide portion (18) and saidanvil (22).
 6. Stapling instrument according to claim 5, characterizedin that said guide portion (18) and said anvil (22) are rigidlyconnected by means of at least one arm (20) extending from at least oneend of said anvil (22) and generally running in parallel to thelongitudinal axis (L) of said body portion (3) of said instrument (1).7. Stapling instrument according to one of claims 1 to 6, characterizedin that the distance between said cartridge (10) and said anvil (22) inthe closed position is adjustable.
 8. Stapling instrument according toone of claims 1 to 7, characterized in that said staple driving device(6, 52, 53) is adapted to simultaneously drive the staples (54, 55, 56)out of said cartridge (10) towards said anvil (22).
 9. Staplinginstrument according to claim 2 or 3 and to claim 8, characterized inthat said knife actuating device (6, 52, 53) is adapted to cause saidknife (58) to protrude from said cartridge (10) after the staple pointshave been driven out of said cartridge (10).
 10. Stapling instrumentaccording to claim 9, characterized in that said staple driving device(6, 52, 53) and said knife actuating device (6, 52, 53) are mechanicallycoupled for operation via a common trigger (6).
 11. Stapling instrumentaccording to one of claims 2 to 10 in connection with claim 2,characterized in that said knife (58) is removable.
 12. Staplinginstrument according to one of claims 1 to 11, characterized in thatsaid cartridge moving device (5, 12, 16, 18) includes a trigger lever(5) for actuating the movement of said cartridge (10).
 13. Staplinginstrument according to one of claims 1 to 11, characterized in thatsaid cartridge moving device includes a threaded shaft coupled to arotatable knob for actuating the movement of said cartridge. 14.Stapling instrument according to one of claims 1 to 13, characterized inthat said anvil (10) has an atraumatically shaped distal end region(24).
 15. Stapling instrument according to one of claims 1 to 14,characterized in that said staple fastening assembly (8) is removablymounted in the distal end region (9) of said body portion (2, 3). 16.Stapling instrument according to one of claims 1 to 15, characterized inthat said cartridge (10) is removable.
 17. Stapling instrument accordingto one of claims 1 to 16, characterized in that the radius of curvatureis essentially infinite.
 18. Staple fastening assembly, characterized bythe features of the staple fastening assembly (8) as defined in one ofclaims 1 to
 17. 19. Cartridge, which is adapted to the staplinginstrument (1) according to claim 16.